Stent treatment or surgical closure for perforated duodenal ulcers: a prospective randomized study
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and Other Interventional Techniques
2020 SAGES ORAL
Stent treatment or surgical closure for perforated duodenal ulcers: a prospective randomized study Jorge Alberto Arroyo Vázquez1,4 · Kaveh Khodakaram2 · Maria Bergström3,4 · Per‑Ola Park3,4 Received: 1 June 2020 / Accepted: 6 November 2020 © The Author(s) 2020
Abstract Background Perforated peptic ulcer is a life-threatening condition. Traditional treatment is surgery. Esophageal perforations and anastomotic leakages can be treated with endoscopically placed covered stents and drainage. We have treated selected patients with a perforated duodenal ulcer with a partially covered stent. The aim of this study was to compare surgery with stent treatment for perforated duodenal ulcers in a multicenter randomized controlled trial. Methods All patients presenting at the ER with abdominal pain, clinical signs of an upper G-I perforation, and free air on CT were approached for inclusion and randomized between surgical closure and stent treatment. Age, ASA score, operation time, complications, and hospital stay were recorded. Laparoscopy was performed in all patients to establish diagnosis. Surgical closure was performed using open or laparoscopic techniques. For stent treatment, a per-operative gastroscopy was performed and a partially covered stent was placed through the scope. Abdominal lavage was performed in all patients, and a drain was placed. All patients received antibiotics and intravenous PPI. Stents were endoscopically removed after 2–3 weeks. Complications were recorded and classified according to Clavien-Dindo (C-D). Results 43 patients were included, 28 had a verified perforated duodenal ulcer, 15 were randomized to surgery, and 13 to stent. Median age was 77.5 years (23–91) with no difference between groups. ASA score was unevenly distributed between the groups (p = 0.069). Operation time was significantly shorter in the stent group, 68 min (48–107) versus 92 min (68–154) (p = 0.001). Stents were removed after a median of 21 days (11–37 days) without complications. Six patients in the surgical group had a complication and seven patients in the stent group (C-D 2–5) (n.s.). Conclusions Stent treatment together with laparoscopic lavage and drainage offers a safe alternative to traditional surgical closure in perforated duodenal ulcer. A larger sample size would be necessary to show non-inferiority regarding stent treatment. Keywords Perforated duodenal ulcer · Duodenal stent · Peptic ulcer perforation
Background Perforated peptic ulcer is a life-threatening complication in ulcer disease. About 2–14% of all peptic ulcers are believed to perforate, with an incidence of 4–11/100,000 per year in
* Jorge Alberto Arroyo Vázquez [email protected] 1
Department of Surgery, South Älvsborg Hospital, Brämhultsvägen 53, 501 82 Borås, Sweden
2
Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
3
Department of Surgery, Halland Hospital, Varberg, Sweden
4
University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
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